ABSTRACTS: Oral Presentation Abstracts
Introduction: Cyclosporine A(CyA) and tacrolimus(Tacro) are the principal immunosuppressive agents used for OLT in children. Progress ive deterioration of renal function from calcinerin inhibi tor (CNI) toxicity after OLT has been reported. Aim: To assess long-term renal function in children after OLT.
Methods: We reviewed all OLT patients surviving >1 year at Saint-Justine Hospital from 1987 to 2003. The GFR was measured yearly by the Tc-99mDTPA single injection technique.
Results: 101 OLT patients were included: tyrosinemia (Tyr) (27), biliary atresia (33), fulminant hepatic failure (5), and miscellaneous (36). Post-operative renal insufficiency required ATG in 5, and was associated with ganciclovir in 15 and amphotericin B in 9. Tyr patients were analysed separately from the rest (Others). Median age at OLT was 35 mo.(range 6–178) in Tyr group and 58 mo.(range 1–226) in the Others (p=ns). PELD score was 3 (range-9–21) and 15 (-9–50),p=0.001, mean follow-up 8.9(CI95% 7.6–10.1) and 6.7(CI95% 5.9–7.6) years, respectively. At 1 year post-OLT, 65/101 (64%) (9/18 Tyr) were on anti-hypertensive (a-h)therapy and at 5 years, 22/73 (30%) (9/17 Tyr). Mean duration of a-h therapy in Tyr group was 4.7(CI95% 3.4–6.1) vs. 2.5(CI 95% 1.9–3.1) years in the Others. Outcome: GFR remained stable in both groups in follow-up of up to 12 years (Tab 1). No differences in GFR occurred between groups by gender, CNI levels or per kg dose. CyA was switched to Tacro in 54 patients (53.5%), at a median of 5.5 years (range 1–13) after OLT. GFR did not differ on CyA vs Tacro; 86.9± 6.4, vs. 88.2±5.3(p= 0.7) in Tyr group and 94.5 ±3.06 vs. 101.1±4.49(p=0.084) in Others group. In 6 patients, followed for 6–10 years, the GFR gradually decrea sed from 101–120 to 44–80. All 6 received CyA in 3 daily doses. Diltiazem was given in 3/6 patients; 2/6 received calcium antagonists. CyA was switched to Tacro in years 7 and 8 post-OLT in 3/6.
Conclusion: Mean GFR remained normal in most non-tyr patients. Tyr patients also remained stable but at lower levels of GFR. CyA in 3 daily doses and prolonged therapy with calcium antagonists (64% overall) may have contributed to this stability. No significant change in GFR followed the switch to Tacro and cessation of calcium antagonists.